Dawn of a New Era for Stroke Treatment
Implications of the DAWN Study for Acute Stroke Care and Stroke Systems of Care
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Until recently, the selection of patients with large artery occlusion and ischemic stroke for reperfusion therapy was based on time criteria (typically within 6 hours) and basic imaging protocols (head computerized tomography [CT], CT angiogram, and ASPECTS score [Alberta Stroke Program Early CT Score]). The recently published DAWN study (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) has changed this paradigm by using tissue-based selection criteria and a greatly expanded treatment time window (up to 24 hours).1 This is a transformational change in acute stroke therapy and has implications for many healthcare providers and emergency medical services (EMS) systems.
Patient Selection Using Advanced Imaging
Key to the selection of patients that may benefit from mechanical thrombectomy is identifying those with a relatively small area of core infarction. All patients in the DAWN study had clinical and CT angiography evidence of a large artery occlusion (distal internal carotid or proximal middle cerebral artery) causing a significant neurological deficit. Patients then had core size and salvageable areas determination using 1 of 2 modalities: CT perfusion or MR diffusion. For both modalities, analysis of the size of the core was determined …